What is Bilateral Vestibular Hypofunction

Your vestibular system is a vitally important structure located in your inner ear. It is responsible for balance, equilibrium, spatial awareness, and more. It is connected to the cochlea and depends on fluid, nerves, and ear crystals (otoconia) for function. Vestibular hypofunction is a common dysfunction and means that your vestibular system is functioning ‘less’ than it should be (hypo=less). A unilateral vestibular hypofunction is more common than bilateral, and that’s why you find so much more information on it on Google.

Unilateral vestibular hypofunction means that one of your vestibular systems is working suboptimally. Bilateral vestibular hypofunction means both of your vestibular systems are working suboptimally. In rehabilitating a unilateral dysfunction, the opposite side can be used to help you compensate for the other side. However, with bilateral vestibular dysfunction, both sides have some sort of dysfunction, and cannot be used to compensate, adapt, and/or habituate.

What Causes Bilateral Vestibular Hypofunction?

Bilateral vestibular hypofunction can come from many pathologies. Those with vestibular migraine, bilateral Meniere’s disease, history of meningitis, CANVAS, superficial siderosis, and others can cause bilateral vestibular hypofunction. Regardless of the causation, once you have bilateral loss it’s important to understand what it is, how to manage it, and how to take care of the rest of your health.

Symptoms of Bilateral Vestibular Hypofunction

  • imbalance
  • dizziness
  • instability
  • disequilibrium
  • oscillopsia/gaze instability
  • visual vertigo
  • brain fog
  • fatigue
  • other cognitive deficits

If the bilateral vestibular hypofunction is a result of another neurological disease, you may also be experiencing alternative symptoms secondary to the diagnosis.

Bilateral Vestibular Hypofunction Management

Managing bilateral vestibular hypofunction is about much more than medication, in fact, in the chronic phases of bilateral vestibular hypofunction it’s recommended not to use medication, but o use vestibular rehabilitation therapy and exercise to promote healing (1). In a randomized control trial, those who underwent vestibular rehabilitation treatment had significantly better outcomes in function and balance than those who had no treatment or only used medications. This is likely because the mediations typically prescribed are vestibular suppressants and anti-emetics. Vestibular suppressants will actually hinder your system’s function further, and anti-emetics are only to treat the symptoms so nausea and vomiting associated with vestibular dysfunction.

Managing bilateral vesitbular hypofunction requires strengthening your physical body, improving the use of your proprioception, maintaining eye health, and continuing your general health. You have three balance systems, and one (your vestibular system) is not functioning at 100%, but strengthening the other two (vision and proprioception) will help you maintain the best balance possible. Additionally, taking care of your physical health, preventing other morbidities like diabetes or cardiovascular dysfunction, and staying as fit as you are able will help you keep your balance and equilibrium as much as possible.

What is Compensatiton

With a permanent injury to any system, the body uses another system or external resource (like a cane) to make up for the loss of the damaged system. In a unilateral vestibular hypofunction, the adaptation of the brain and opposite vestibular system returns your equilibrium to a new normal by rewiring brain pathways (through neuroplasticity). With bilateral vestibular hypofunction, since we cannot use the opposite system to adapt and compensate, you may need to employ other tactics.

For bilateral vestibular hypofunction, external compensation tactics are frequently a good idea. I recommend the following:

  • A cane or walker for uneven or difficult environments
  • Flat shoes with good match support so you are able to feel the floor (avoid shoes with high platforms or a heel)
  • Wear migraine classes if you are light-sensitive
  • Wear earplugs if you are sound sensitive

Bilateral Vestibular Hypofunction Requires…

A lot of attention to yourself and your balance systems. I know that this is true for all vestibular dysfunctions, but especially for Bilateral Vestibular Hypofunction. What questions do you have about BVH I can help you answer? Comment below, or shoot me an email!

Vestibular Group Fit has Premium Content dedicated to understanding Bilateral Vestibular Hypofunction. Strengthening your legs and body is one of the best things you can do to improve function and feel less wobbly with Bilateral Vestibular Hypofunction. 


(1) Horak FB, Jones-Rycewicz C, Black FO, Shumway-Cook A. Effects of vestibular rehabilitation on dizziness and imbalance. Otolaryngol Head Neck Surg. 1992;106(2):175-180. PMID:1738550

2 thoughts on “What is Bilateral Vestibular Hypofunction”

  1. Hi Dr. Madison,
    I have been diagnosed with Bilateral Vestibular Hypofunction, and wondering whether or not being exposed to hazardous noise levels can lead to Bilateral Vestibular Hypofunction?


    1. Avatar photo

      Hello! Great question. Being exposed to loud noise levels could lead to hearing loss, but from what I’ve seen in the research BVH is not caused by loud noises. I hope this helps!

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